Provider Demographics
NPI:1558469437
Name:HOROWITZ, JEFFREY S (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4104
Mailing Address - Country:US
Mailing Address - Phone:845-986-2058
Mailing Address - Fax:845-986-7669
Practice Address - Street 1:10 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4104
Practice Address - Country:US
Practice Address - Phone:845-986-2058
Practice Address - Fax:845-986-7669
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157781-1208000000X
NJ25MA06670800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00836035Medicaid
NJ0393100Medicaid
NYA400015026Medicare PIN
NYA400015027Medicare PIN